Eat a bit less, move a bit more

By Dr. B. Dale Magee

Tuesday

Jan 31, 2012 at 12:16 AM

Worcester's Division of Public Health has undertaken an analysis of the top causes of premature death (no offense to those over 75, but this is defined as death before the age of 75). What we found is that cancer, cardiovascular diseases and overdoses were at the top of the list.

Looking a little deeper we found that, by far, the main cause of cancer death was cancer of the lung — 90 percent of which is related to smoking. We also know that smoking drives cardiovascular deaths, with the risk of premature deaths from a heart attack being about five times higher for smokers. Add to this the increased risks of unhealthy weight, which can drive up cholesterol and blood pressure, and we begin to see why this has happened.

Among adults in Worcester, nearly two-thirds are overweight or obese. For overdoses, we learned that opiates, especially heroin, were behind what we were seeing.

Here is where it gets more interesting. We have causes of death, and we have habits such as smoking, unhealthy weight and narcotic use that appear to be behind these premature deaths. But, what we already know is that getting someone to stop smoking, or lose weight or stop using narcotics is extremely difficult. Success rates for any of these are way under 50 percent.

So the key would seem to be prevention, but when do people with these habits begin?

Four out of five smokers begin before the age of 18, over 90 percent of those addicted to narcotics begin in adolescence and, increasingly, obesity is becoming common in childhood — with one in five children entering school being obese. We know that a child who is obese at age 8 has a greater than 90 percent chance of being at least overweight as an adult.

What could there be in our environment that could be leading to these outcomes, and what can we as a community do? The DPH has reached out to a variety of community organizations to see how we all can apply ourselves to making our children and our adults healthier.

Parents and legislators have been educated regarding tobacco products targeted at children. Products that look and taste like candy, but are laced with enough nicotine to produce addiction, are available, and we need to keep them away from our children.

The road to heroin often begins with prescription drug abuse, and this usually starts with medications that have been misappropriated from home or a friend's house. Experimentation leads to dependence and then to harder drugs.

Doctors need to be made more aware of this and try to make greater use of non-narcotic pain relievers. The U.S. has 5 percent of the world's population and yet we consume over half of the prescription narcotics. There has to be a better way.

We also need better ways to dispose of narcotics as soon as we are done with them so they are not around to be shared. Today, even overdoses in children under five have increased by over 35 percent in the past decade.

Being overweight is something that is apparent to everyone, and the associated diseases are major problems in Worcester, as elsewhere. One in three adults has elevated cholesterol, one in four has high blood pressure, and one in 11 has diabetes. All of these are major risk factors for premature heart attack and stroke. Nationally, the prevalence of obesity has increased at such a rate that the highest state rate of obesity 20 years ago is now lower than the rate of obesity in the slimmest state.

How could this be?

Well, human nature has not changed — we have always liked to eat. But our world has. Less exercise and an average of five hours of screen time have contributed. But so have portion sizes. Thirty years ago, the typical burger was two ounces. Today, four ounces is the rule, and eight ounces with bacon and cheese are not hard to find. Simply upsetting the energy balance by about 100 calories a day is enough to put 10 pounds per year on a person.

This is about what we are seeing nationally. We need to eat a little less and move a little more.

Working with a group of medical students, the DPH and community leaders are moving to partner with local restaurants to offer more modest portions as a clear option. Through our Mass in Motion program we are working to make Worcester an easier place to bike and walk in.

Finally, we cannot overlook the fact that children learn from their parents, and parents, who themselves may have been acculturated to an unhealthy environment, can benefit from tools to work with their children to make better choices. Knowing that help is available can be a great comfort to those parents who would like to learn more. Through a number of venues, various organizations will pilot programs of parental tools to help interested parents to provide their children with a better future.

The key to a healthy old age lies in our children.

Dr. B. Dale Magee is commissioner of public health in the city of Worcester.

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